Many past CIAs and Agreements contain language requiring that a statistically valid sample of claims be reviewed. How does the OIG interpret this provision?
The intent of this provision, as used in Settlement Agreements and CIAs, is that the provider will randomly select through a statistically valid method an adequate number of sampling units to be reviewed. The number of units selected must be large enough to draw reasonable conclusions regarding overpayments that exist in the population from which the sample was selected. (Note: The sampling unit does not have to be a claim. Therefore, the reviewer should define the sampling unit.) If the reviewer is not using the Probe or Discovery Sample approach to determine the number of sampling units to be reviewed, the rationale for selecting the number of sampling units that were reviewed should be included in the report.
Answer 4: The intent of this provision, as used in Settlement Agreements and CIAs, is that the provider will randomly select through a statistically valid method an adequate number of sampling units to be reviewed. (Note: The sampling unit does not have to be a claim. Therefore, the reviewer should define the sampling unit.) The number of units selected must be large enough to draw reasonable conclusions regarding the population from which the sample was selected. If the reviewer is not using the probe sample approach to determine the number of sampling units to be reviewed, the rationale for selecting the number of sampling units that were reviewed should be included in the report.
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